Understanding cardiac rehabilitation delivery during Covid-19; lessons for future delivery; a mixed methods study

Abstract

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Scottish Funding Council (additional research funding for universities 2020-21) Background/introduction Cardiac rehabilitation (CR) services were disrupted during early COVID-19 due to limited interpersonal contacts, exercise facility closures, and clinical service reorganisation to meet COVID-19 patients’ needs. This necessitated urgent service reorganisation. Purpose We aimed to understand CR delivery changes in Scotland, the impact on staff and participant experiences, and implications for future delivery. Methods A concurrent mixed methods study with data collected between April-December 2021. A quantitative online survey compared CR service provision pre-COVID-19 (21 March 2019 – 20 November 2019) with provision during early COVID-19 (21 March 2020 – 20 November 2020). Quantitative data were analysed descriptively using SPSSv26. Qualitative semi-structured telephone interviews were conducted with CR professionals and CR participants. These were thematically analysed using the framework approach. Data were integrated during study design by aligning survey and interview questions, and at the discussion stage. Results Eleven CR services completed the online survey, and 11 individual CR staff and 17 CR participants from six services completed qualitative interviews. Services reported staffing reductions, delayed initial patient contact, replacing face-to-face CR with web-based and telephone support, and a reduction in goal setting, functional capacity testing and exit assessments. Three main qualitative themes represented the challenges and opportunities of changing CR delivery during COVID-19: 1) Access to health professional support; 2) Disruption in continuity of care and 3) CR technology use (Figure 1). Conclusions Initially, Covid-19 adversely affected CR delivery. Telephone support, the provision of web-based information and exercise options, wearables and mHealth apps can enhance future CR delivery. Technological resources must be accessible, and staff require training to ensure competency.